David Cullinane (Waterford, Sinn Fein)
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3. To ask the Minister for Health the number of hospital-initiated elective cancellations in 2023; and the number of elective procedures outsourced to private medicine in public hospitals or private hospitals in the same period. [2055/24]

David Cullinane (Waterford, Sinn Fein)
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There is lots of information that we unfortunately cannot get through parliamentary questions. I understand the reason, namely, that there is an industrial relations dispute. I respect the right of people to engage in that. The information I am looking for is on the number of hospital-initiated cancellations for elective procedures. As we know, when the pressure is on in emergency departments, often one of the first things to happen is that elective procedures are cancelled, almost wholesale. How many cancellations in 2023 were initiated by hospitals?

Stephen Donnelly (Wicklow, Fianna Fail)
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I can provide the Deputy with information to the end of quarter 3. Unfortunately, Fórsa workers are refusing to provide information to the HSE, the Department and Parliament. This does not fall within a work-to-rule action, and I have clear advice on that. Nonetheless, that is what they are doing and we have to deal with it.

I acknowledge the distress this has caused to patients and families. I have been in the position, as have many others, I am sure, where a family member or friend has been waiting for a procedure, be it a minor procedure or a major operation. There is a lot involved in that. People look forward to it and they can be nervous. They may be admitted the night beforehand and may go through full preparation only to be told the theatre is not available because there has been a road traffic accident. They may be told a high-dependency bed is not available for them after the procedure, typically because something has happened in the accident and emergency department. That can cause a lot of distress.

As regards the figures the Deputy asked for, at the end of quarter 3 last year, there had been 30,833 cancellations. It is important to contextualise that number. It is 2% of the total number of procedures. While it is a large number, it is in the context of about 1.5 million procedures. Critically, when I was looking through the Deputy's question earlier this week, I asked the Department to talk to the HSE about how many of those cancelled procedures were rescheduled. It is one thing for a procedure to be cancelled but it is important that patients get care. The HSE has indicated that in a large majority of those cases, the procedure will have been rescheduled and the patient will have received either the care or a new appointment.

David Cullinane (Waterford, Sinn Fein)
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We all know the majority of cases are rescheduled. The problem is that people end up waiting longer. By cancelling elective procedures because of pressures in accident and emergency departments, we end up just shifting the problem from one part of the health service to another. I respect the fact that there is an industrial relations dispute, but it is extraordinary that the Minister, the Department and the HSE, at a senior level, are not being given information on basic data like the number of hospital cancellations. There is lots more information I have sought that we cannot get. My message to the Minister is to resolve that industrial relations dispute by engaging with Fórsa. It is not tenable to be in the position where basic information cannot be delivered to the Opposition or the Minister for Health.

While I am talking about the cancellation of elective procedures, I put it to the Minister that there is an awful lot of foot dragging with the elective-only hospitals. We have not even identified sites in Dublin yet, years after the delivery of those hospitals was promised. We are a long way away from delivering them in Cork and Galway. That will be the real solution to the problem of elective procedures being cancelled.

Stephen Donnelly (Wicklow, Fianna Fail)
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There are a few things to unpick there, the first of which is around waiting times for inpatient and day-case patients. There is good news in that regard. The Deputy will have seen the releases in recent weeks. We have looked at 2023. Thanks to an enormous effort by healthcare workers across the country, the waiting time versus the Covid peak for someone waiting the longest - over 12 months - has fallen by nearly half. We will continue to make progress. Great efforts have been made in every hospital to make that happen. The waiting time, particularly for long waiters, is falling quickly, which is something we all want to see.

On elective work, I share the Deputy's frustrations with the processes by which the State engages in building hospitals. It is deeply frustrating, which is why I sanctioned six surgical hubs. One of them will be in the Deputy's neck of the woods, in University Hospital Waterford. I visited Mount Carmel Community Hospital, where the first one is under construction. We will take over that hub in the coming months. The surgical teams I am talking to believe these hubs can be a game-changer for people waiting for procedures, both inpatient and day case.

David Cullinane (Waterford, Sinn Fein)
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I welcome the surgical hubs, as anybody would, but they are not a substitute for the elective-only hospitals. I share the Minister's frustration but I have also expressed frustration about the slow pace of delivery of elective-only hospitals. We are talking about lots of big infrastructural projects in healthcare. Members of the Joint Committee on Health get frustrated with digital transformation and all the other big projects that take far too long.

The political system will have to deal with the fact that we have to challenge conservative thinking in the Department of Public Expenditure, NDP Delivery and Reform. The political system is prioritising major projects in housing and health, especially projects such s elective-only hospitals which will make a huge difference and provide additional elective capacity. That is the big reform that will drive down wait times like never before. The waiting and foot-dragging is mainly caused by the Department of Public Expenditure, Reform and NDP Delivery but the political system is also at fault for not challenging and changing it. That is one of the big changes that has to happen in 2024.

Stephen Donnelly (Wicklow, Fianna Fail)
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There have been some important changes. I brought this matter to the Ministers, Deputies McGrath and Donohoe, some time ago in regard to major capital projects in healthcare. There have been some important changes and I will mention two in particular. First, the major capital ceiling was increased by €100 million to €200 million and, second, the four-stage process was reduced to two stages and is now moving quicker. I do not disagree with the Deputy's comments, not so much in terms of the Department of Public Expenditure, NDP Delivery and Reform but in terms of the process itself, which is a painstaking one. Nonetheless, none of us should underestimate the impact these surgical hubs will have. We have seen a massive reduction in long waiters in Tallaght. The hub in Mount Carmel will serve St. James's Hospital and St. Vincent's Hospital. We are going to have one in Swords that will serve the major hospitals on the north side of the city-----

Stephen Donnelly (Wicklow, Fianna Fail)
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We will then have them in Waterford, Cork, Limerick and Galway. They will make a big difference to the national inpatient day-case lists.

David Cullinane (Waterford, Sinn Fein)
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I do not dispute that.